title: The predictive value of preoperative natriuretic peptide concentrations in adults undergoing surgery: a systematic review and meta-analysis.
abstract: BACKGROUND
  Several studies have evaluated preoperative B-type natriuretic peptides (NPs) for predicting mortality after surgery; however, the number of deaths in each study was small, limiting the power of these studies. We conducted a systematic review and meta-analysis of studies addressing preoperative NP levels to predict mortality after cardiac and noncardiac surgery.
  
  
  METHODS
  We searched MEDLINE and EMBASE using the terms "natriuretic peptides," "surgery or surgical procedures," and a validated combination of prognostic and diagnostic terms. Two investigators independently assessed studies for eligibility and extracted data. The end points were all-cause mortality at ≥6 months and at ≤90 days. We used a bivariate model to derive measures of prognostic accuracy and their heterogeneity. We calculated the pooled positive predictive value (PPV) and negative predictive value (NPV) by Bayesian Markov chain Monte Carlo methods.
  
  
  RESULTS
  Of the 1558 retrieved articles, 23 studies satisfied the predefined eligibility criteria. After cardiac surgery, the diagnostic odds ratio of NP was 4.11 (95% confidence interval, 2.22-7.60) for ≥6-month mortality, the PPV 0.17 (95% Bayesian confidence interval, 0.07-0.36), and the NPV 0.96 (0.90-0.98). After noncardiac surgery, the diagnostic odds ratio of NP was 4.97 (3.06-8.07) for ≥6-month mortality. The corresponding PPV was 0.24 (0.14-0.38) and the NPV 0.94 (0.88-0.97). Results were similar for ≤90-day mortality.
  
  
  CONCLUSIONS
  Preoperative NP concentrations were associated with mortality after cardiac and noncardiac surgery. NP had high NPVs for both types of surgery suggesting that preoperative NP concentrations may be helpful in preoperative risk stratification.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, University Hospital Basel, Spitalstrasse 21CH-4031, Basel, Switzerland. glurati@uhbs.ch
authors.forename: Giovanna A
authors.initials: GA
authors.lastname: Lurati Buse
authors.forename: Michael T
authors.initials: MT
authors.lastname: Koller
authors.forename: Christoph
authors.initials: C
authors.lastname: Burkhart
authors.forename: Manfred D
authors.initials: MD
authors.lastname: Seeberger
authors.forename: Miodrag
authors.initials: M
authors.lastname: Filipovic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D015415:Biomarkers / Q000097:blood*; D006348:Cardiac Surgical Procedures / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D045265:Natriuretic Peptides / Q000097:blood*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000401:mortality*; D011237:Predictive Value of Tests; D057234:Preoperative Period; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides